San Francisco, CA USA (UroToday.com) Docetaxel and new hormonal therapies (NHT, abiraterone and enzalutamide) are appropriate first line options in metastatic castration-resistant prostate cancer (mCRPC). There is presently not reliable guidance for choosing the best option. Turpin and colleagues performed an audit of real-life practice among French physicians in order to assess local practices. The objective was to describe (1) the criteria for selecting docetaxel or NHT as first-line treatment in mCRPC and (2) the follow-up modalities in this clinical setting.
An online questionnaire was created and consistent of 22 questions. Of 481 physicians to whom the survey was sent, 109 (22.6%) completed the questionnaire. The group was comprised of 52 medical oncologists, 23 urologists, and 2 other specialists. The selection criteria for choosing docetaxel first were presence of visceral metastases (79.8%), heavy tumor burden (68.8%), aggressive tumor disease (66.1%), and short-term efficacy of castration (66.1%). The selection criteria for choosing NHT were long-term efficacy of castration (66.1%), older age (67.9%), low tumor grade (56.9%), and absence of symptoms (54.1%). Tumor assessment after initiation of docetaxel was performed most commonly after 3 cycles including PSA, chest/abdomen/pelvis CT, and bone scan in 96.3%, 68.8%, and 59.6%, respectively. For NHT, tumor assessment was performed after 3 months of therapy and included PSA, chest/abdomen/pelvis CT, and bone scan in 90.8%, 61.5%, and 63.3% of cases.
The authors noted that this was the first audit of real-life French oncologists with a large and varied experience in treating mCRPC. The therapeutic choice between docetaxel and NHT is in accordance with the St. Gallen consensus of 2015. They concluded that there appears to be a need for guidelines in the management of mCRPC, especially for the assessment of the tumoral response.
Presented By:
Anthony Turpin
Reported By:
Benjamin T. Ristau, MD at the 2016 Genitourinary Cancers Symposium - January 7 - 9, 2016 – San Francisco, CA
Fox Chase Cancer Center, Philadelphia, PA